title: Tumor necrosis factor-α in vitiligo: direct correlation between tissue levels and clinical parameters.
abstract: BACKGROUND
  Experimental evidences have shown that tumor necrosis factor (TNF)-α may play a role in the pathogenesis of nonsegmental vitiligo, and successful cases of vitiligo treated with TNF-α inhibitors have been recently reported.
  
  
  METHODS
  Two cases of refractory generalized vitiligo, which showed high tissue levels of TNF-α, were commenced anti-TNF-α antibody etanercept 50 mg weekly. A retrospective study, considering chart review and immunohistochemical staining for TNF-α, was then carried out on eight additional patients affected by untreated vitiligo.
  
  
  RESULTS
  Etanercept achieved improvement of vitiligo in two patients at 6-month follow-up. Five out of eight specimens showed a strong cytoplasmic staining for TNF-α. Considering all 10 cases, patients with a strong TNF-α staining were characterized by a higher vitiligo disease activity score than patients with a weak staining.
  
  
  CONCLUSIONS
  These findings, albeit limited in significance by the low number of cases and the retrospective nature of the study, confirm a probable role of TNF-α in the pathogenesis of vitiligo. The intensity of TNF-α staining in vitiligo lesions may be worth to be further studied as a biomarker for potentially successful anti-TNF-α treatment of nonsegmental vitiligo in cases refractory to conventional treatment.
authors.affiliation: University of Miami Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL 33125, USA.
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Kim
authors.forename: Daniele
authors.initials: D
authors.lastname: Torchia
authors.forename: Panta
authors.initials: P
authors.lastname: Rouhani
authors.forename: Brenda
authors.initials: B
authors.lastname: Roberts
authors.forename: Paolo
authors.initials: P
authors.lastname: Romanelli
mesh_terms: D000328:Adult; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use*; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014820:Vitiligo / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept